Sunday, October 13, 2013

Complications: A Continuation of the Last Story

She kept getting better. But it seems medicine, and it’s
providers, kept fighting against her. Two days after surgery I noticed her leg
was swollen. I knew that she had a clot in it. I looked at the chart, making
sure that I had not forgotten to write for the medicine meant to prevent this
particular complication. No, the order was there. As well, another order was
right above it, written by the surgery team, which ordered the exact same medicine.
Written twice, but never given. I called the nurse, and no, that medicine hadn’t
been given. “It must have been overlooked”, they answered as if it were no big
deal. But it was a really big deal to me. They continued explaining, “maybe the
chart was moved by one of your colleagues”, and “we have been very busy”.
Finally the gasket blew (it isn’t always that firmly attached anyhow, and this
episode of apathy flipped it off). I explained heatedly that I didn’t care
about any of the excuses, what I cared about was if my patient got her
medicines. I emphasized that she could die from this. And how I wrote those
orders to prevent stuff like this. And again said that the least important
thing to me is the excuses that keep coming. That explanation probably did very
little to encourage my relationships with nursing, but I lacked the strength to
hold it back.

In spite of her setback, she started getting better. I had one of
the medicine doctors seeing her to make sure her blood clot was being managed
correctly. Better and better and better. She always smiled, and it delighted me
to finally see her condition catching up with her attitude. She was actually
getting better. I transferred her medical care to other doctors to manage her
clotting issues and her chemotherapy treatments. I couldn’t really let her go though, I thought
of her every day, so found myself going by to make sure she was hanging in there,
or to have a quick word of prayer with her.

I got the final pathology back. It was a cancer that is rare, but
can be very aggressive. In fact, it was the one I was hoping most against. I
went to tell her. I had to make her understand. Medical terms would be lost, so
I went with a more accurate description – “I was hoping it would be a type that
we could really squash dead, but it is a type that is much harder to kill, and
even with the treatment, it could come back”. I told her about the medicines
she was going to be taking. How they were cruel to the body, but how she had to
hold on, even through the hard times. Looking at her little frail body, I was
surprised to hear her so excited to fight against it. And so she did. Made it
through the first round of chemo weak but vibrant, and smiling as always.

About a week passed. Just a few days after she was readmitted for
more chemo, I got a call from her brother. He said she was not breathing well
and was confused, and that he couldn’t find a doctor. I hung up and called the
medical doctor at the hospital to please go and see her. Soon it was clear. Her
issues had been “lost” on the readmission. The new doctor didn’t know her well.
No one was following her issues. The medicine to treat the blood clot had been
forgotten. She died the next morning of a clot that moved to the lung.

I had poured my heart out into her. I cared too much. She loved it
when I came to see her. She loved that I would walk through it, and hope
through it with her. I loved to watch her get better. But caring wasn’t enough. It seemed that it was an
avoidable death, a greater tragedy than when a loss couldn’t have been
prevented. Too many things had gone wrong one after the other, leading to the
loss of life. I was discouraged and frustrated. And just plain sad.

It is a hard reminder that my best is not enough. That medicine
isn’t enough. Out here we need better training, better management, a better
system. Our resources, including both human resources and medical resources, are
stretched too thin. In fact, for most of the society here such loss of life is accepted
as normal. It is not the exception. All those things really are issues. But if
they were fixed, it still wouldn’t be enough. It still couldn’t make sense of
the madness of circumstances that we pass through. It couldn’t make sense of
our losses.

But my patient seemed to make sense of life, at least to me. In
spite of her circumstance, I never saw a bad attitude. She never complained,
though she certainly had reason. There was no feeling sorry for herself. In the
midst of great pain, she pushed through with a smile. Over one hurdle, over
another, she just kept climbing. While I was frustrated and tired from fighting
on her behalf, she was just resting and trusting that God would care for her.
She did want the medical care, she wanted help, but she knew that it wasn’t
ultimate. She could rest in Him.

Too often I cannot rest. I am too busy fighting. I fight on behalf
of my patients. I push to make the staff provide better care. I fight for the
injustices I see all around. Sometimes I work as though I am holding up
everything around me. Frustrations abound because I carry more than I am meant
to. My grasp is a bit too tight. One day I will know better how and what to
fight. One day I will know better how to rest in Him.

For this time, in spite of the struggles and frustrations, I have
lost the battle on her behalf. Yet still she rests, now more completely than
she ever has.